- Indian Echinacea
- Chuan Xin Lian
For Patients & Caregivers
Andrographis has been mostly studied for the treatment of colds, flu, and upper respiratory infections. Lab studies suggest possible anticancer effects, but this has not been confirmed in humans.
Andrographis paniculata is used in traditional medicine to treat infectious diseases and fevers. Andrographis exhibits antibacterial, antioxidant, anti-inflammatory, anticancer, and immunostimulating properties. Either alone or in combination with other herbs, andrographis has been shown to reduce duration and severity of upper respiratory infections such as those associated with the common cold or flu. Andrographis extract may benefit patients with ulcerative colitis. It also reduced symptoms of rheumatoid arthritis. However, patients should use caution before using this herb as it may interact with many drugs.
Colds and Flu
Either alone or in combination with other herbs, andrographis may reduce duration and severity of cold and flu symptoms.
In a small trial of patients infected with HIV, andrographolides, the active ingredients in andrographis, increased the number of lymphocytes, suggesting improved immune function. However, the trial was interrupted midway due to an adverse event.
In vitro and animal studies suggest antioxidant and anticancer properties. However, it is unclear if this herb has any beneficial effects in humans as a cancer treatment.
A small clinical trial showed that andrographis extract relieved rheumatoid arthritis symptoms. However, further study is needed to confirm this effect.
In a clinical trial of patients with ulcerative colitis, use of andrographis extract resulted in clinical response or full remission. However, further study is needed to confirm these effects.
- You are taking chemotherapy drugs: Andrographis has antioxidant effects and may interfere with the actions of chemotherapy drugs.
- You are taking drugs that are substrates of cytochrome P450: Although clinical relevance is yet to be determined, andrographis may make some of these drugs less effective and may increase the risk of side effects of others.
- You are taking blood pressure-lowering drugs: Andrographis may have additional hypotensive effects. A study in healthy humans showed transient reductions in blood pressure when taking the suggested dose for common cold and respiratory tract infections.
- You are taking anticoagulants or antiplatelet drugs: Some lab studies suggest andrographis may interfere with these drugs.
- You are taking drugs that are substrates of UDP-glucoronosyltransferase (UGT) 2B7: Lab studies suggest andrographolide derivatives may increase the side effects of drugs metabolized by this enzyme.
- Fatigue, dizziness
- Allergic reactions, hypersensitivity, skin rash
- Lymph node pain or swelling
- Nausea, diarrhea, vomiting
- Altered taste
- Anaphylaxis and allergic reactions: Caused by several different A. paniculata preparations. Methanol extracts may increase this allergy risk.
- Anaphylactic reaction: In an HIV patient on-study during week 4
- Enlarged lymph nodes: With very high doses
- Acute kidney injury: Following intravenous administration of andrographolides. Symptoms included flank pain, decreased urine output, and nausea or vomiting
For Healthcare Professionals
Andrographis paniculata is a bitter tasting annual plant prevalent in much of Asia. It is often used in combination with other herbs in traditional medicine to treat infectious diseases and associated fevers. It is also used in folk medicine to treat snakebites. Andrographis is promoted in supplemental form for cancer prevention, cancer treatment, and to counter chemotherapy toxicity in humans. Formulations containing standardized extracts of andrographis are also marketed for colds and flu.
Kan Jang, a standardized extract of Andrographis paniculata and Eleutherococcus senticosus, has been studied in manufacturer-sponsored clinical trials for relief of respiratory symptoms from cold and flu (1) (2) (3) (4). An andrographis extract was found useful in treating symptoms of upper respiratory infection (5). A few meta-analyses suggest possible benefit with A. paniculata to reduce cough frequency and severity (45) (46).
Andrographis has also been evaluated for ulcerative colitis. In one trial, those receiving A. paniculata extract at higher doses were more likely to achieve a clinical response compared with placebo (47). Another study found it as effective as mesalamine in treating ulcerative colitis (6).
In other preliminary studies, andrographis extracts reduced rheumatoid factors and relieved rheumatoid arthritis symptoms (7). In patients with modest hypertriglyceridemia, a high-dose andrographis extract reduced triglyceride levels in a manner comparable to gemfibrozil (48).
In preclinical cancer studies, andrographolide exhibited activity against multiple myeloma stem cells (49), reversed 5-FU resistance in human colorectal cancer cells (50), and modulated P-glycoprotein-mediated multidrug resistance (51).
The active constituents of andrographis are diterpenoid lactones known as andrographolides (10) (11). They exhibit anti-inflammatory activity by inhibiting nitric oxide production and cyclooxygenase-2 expression (26). In mouse hepatocytes, andrographis induced mRNA expression of P450 subfamily members, CYP1A1 and CYP1A2, in a concentration-dependent manner (31). In other studies, andrographis extract demonstrated a calcium channel inhibition effect that can cause smooth muscle relaxation and decrease blood pressure and heart rate (32), as well as relaxation of the uterus (33). It also showed antiplatelet effects by inhibiting thrombin (34) and platelet activating factor (35). When given orally to mice, andrographis extract was shown to neutralize snake venom (9). In addition, andrographolides inhibit HIV-induced dysregulation of cell cycle and increased CD4+ lymphocyte levels in HIV-1 patients (10).
Andrographolides also demonstrate anticancer effects in preclinical studies. Activity against multiple myeloma cells may occur via TLR4/NF-kappaB signaling pathway inhibition (52). In human colorectal cancer cells, reversal of 5-FU resistance was attributed to elevated BAX expression (50). In addition, migration and invasion was inhibited through suppression of mRNA and matrix metalloproteinase (MMP)-7 protein levels (13), while MMP-2 activity was also identified (14). Inhibition of IL-6 expression and IL-6-mediated signals occurs in human prostate cancer cells (12). In non-small cell lung cancer cells andrographolides reduced invasiveness by suppressing the PI3K/Akt/AP-1 signaling pathway and inhibiting MMP-7 expression (15). Apoptosis in human hepatoma cells occurred via c-Jun N-terminal kinase induction (16) and caspase activation (17). Decreased adhesion of gastric cancer cells to endothelial tissue was attributed to inhibition of E-selection expression (18). Inhibition of tumor cell growth may also occur by stimulating cytotoxic T-lymphocyte production via IL-2 and IFN-gamma secretion (19). Andrographolides also enhanced doxorubicin-induced cell death in several human cancer cell lines, mainly through JAK-STAT suppression (20).
- Anaphylaxis and allergic reactions: Caused by several different A. paniculata preparations. Methanol extraction may increase risk of allergenicity (54).
- Anaphylactic reaction: In an HIV patient on-study during week 4 (10) .
- Lymphadenopathy: With very high doses (53).
- Acute kidney injury: Following intravenous administration of andrographolides. Symptoms included flank pain, decreased urine output, and nausea or vomiting (41).
- Cytochrome P450 substrates: Laboratory studies indicate andrographis extract inhibits 1A2, 2C9, 3A4 (37). Some andrographis compounds also induce CYP1A1 (39). Although clinical relevance is yet to be determined, these properties can affect the intracellular concentration of drugs metabolized by these enzymes.
- Anticoagulants, antiplatelets: Although laboratory studies indicate possible inhibition of platelet aggregation (34) (35), one study in rats suggests that andrographis extract does not interact with warfarin when used concomitantly (38). Patients taking anticoagulant or antiplatelet medications should use caution and consult their treating physician if considering the use of andrographis products.
- Chemotherapy drugs: Andrographolides have been shown to have antioxidant effects (21), which may interfere with the actions of some chemotherapy drugs.
- Blood pressure-lowering drugs: Laboratory studies indicate that andrographis may have additive hypotensive effects (32). In healthy subjects, A. paniculata at the normal therapeutic dose for the common cold and respiratory tract infections modulated various clinical parameters, including transient reductions in blood pressure (55).
- UDP-glucoronosyltransferase (UGT) 2B7: Laboratory studies indicate that andrographolide derivatives inhibit UGT2B7, and can increase the side effects of drugs metabolized by this enzyme (42).
- Aminophylline: Andrographis inhibits CYP1A2, which is involved in metabolizing aminophylline, resulting in increased risk of side effects from this drug (43).